, Volume 37, Issue 4, pp 621–623 | Cite as

The Inclusion of Spillover Effects in Economic Evaluation: A Public Health Economics Perspective

  • Rhiannon Tudor EdwardsEmail author
Letter to the Editor

Dear Editor,

Reading the debate between Brouwer and McCabe about whether spillover costs and outcomes should be included in economic evaluation [1, 2], it strikes me that what is never discussed is the ‘opportunity cost’ of ‘not’ addressing demand side factors in health economics. The estimates of the cost of mental health problems among the UK workforce range from £74 billion to £99 billion per year to the economy, which is equivalent to four-fifths of the whole annual budget of the National Health Service (NHS) in England [3]. It costs one and a half times more to treat the chronic health problems of a person who also has untreated depression than a patient without depression [4].

Sometimes it is helpful to go back to basics. Many students of health economics will recognise the Williams plumbing diagram [ 5] reproduced in Fig.  1. The debate between Brouwer and McCabe is taking place in boxes D (supply of healthcare) and E (micro-economic evaluation at treatment level). As a Public...


Compliance with ethical standards


No funding was received in relation to the writing of this letter.

Conflict of interest

Rhiannon Tudor Edwards has no conflicts of interest to declare.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Centre for Health Economics and Medicines Evaluation (CHEME)Bangor UniversityBangorUK

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